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A couple weeks ago, I wrote about the differences between acupuncture and “dry needling” to alleviate pain, and in that article I explained a bit about the phenomenon of myofascial trigger points. After I said I believe these are the cause of most of the physical pain humans experience, a number of readers asked me to explain more. For the science lovers out there, I’m going to dive deeper this week.
Besides the most common forms of pain, like lower back and headaches, I’ve had patients with digestive problems, sinus congestion, chest pain, ear ringing, numb hands, painful intercourse, acid reflux, vision changes, and other health issues that were eventually discovered to be due to myofascial trigger points. I believe everyone should know about them and how they work – it could save us a lot of time and worry.
Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state, making the muscle fibers taut. This can cause reduced muscle strength and range of motion, pain, numbness, itching, and other forms of dysfunction. Sometimes a trigger point feels like a palpable nodule or “knot,” but to untrained fingers they’re often tricky to find.
A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. For instance, there’s a trigger point that can form in the soleus muscle of the calf that’s capable of producing pain in the lower back. For this reason, the work of Janet Travell, MD and her colleague David Simons, MD, was groundbreaking. For each muscle in the body, they mapped where trigger points tend to form and what kinds of symptoms they cause.
If you were experiencing pain along the outside of your leg, you might assume that something was wrong with that part of your leg, perhaps with the often-tight iliotibial band (IT band). But this diagram might be helpful. The X’s show where trigger points can occur in a muscle called gluteus minimus above the hip socket. The red shading shows the potential areas of pain that can result. You might not suspect this muscle because, as you can see, there’s no pain at the site of the problem!
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. Most often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way.
This is especially common when someone works out without warming up; when someone does a very ambitious workout after not having exercised for a long time; when someone makes a sudden movement (like reaching out to catch something or trying to stop oneself from falling); and especially when someone does any of the above when in a state of diminished resilience (e.g, when stressed, upset, sleep deprived, eating poorly, etc.).
Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years. One possible mechanism is known as the “Cinderella hypothesis.” During static muscle exertion – holding a position for a long time, as dentists, musicians, typists, and others engaged in precision handwork do – the body tends to engage a certain group of small muscle fibers, called Cinderella fibers because they’re put to work first and are the last to be disengaged. Even though they’re not doing heavy lifting, these muscle fibers (often in the neck, shoulders, back, and forearms) are continually activated and overworked, which makes them susceptible to trigger point formation.
Whatever the cause, the result is that eventually the muscle never completely relaxes. Muscles are composed of numerous parallel fibers that work together to shorten (contraction of the muscle) and lengthen (the return of the muscle to its relaxed state). Within each of these fibers are many end-to-end contractile units called sarcomeres, and in the case of a trigger point, a group of sarcomeres gets “stuck” in a shortened state. This makes the affected fibers taut and often “stringy” feeling.
To make matters worse, the contracted region clamps down on tiny blood vessels causing local ischemia (inadequate blood supply), reducing in-flow of fresh, oxygenated blood and out-flow of toxins. This leads to a localized hypoxic state (not enough oxygen). The tissue pH changes, local metabolism is impaired, and fluid and waste products tend to build up in the area. This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less.
Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance. Finally, with longstanding trigger points, the body may deposit gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
The good news is that there are now books, charts, online tools, and practitioners that can help track down likely trigger points that may be implicated in your discomfort. I have such a tool in my online pain relief course, Live Pain Free, and I teach many approaches for deactivating trigger points.
The most basic methods involve simple mechanical disruption of this holding pattern. First, drink some water if you’re not well hydrated. Second, you or a friend can methodically feel around (ideally guided by a trigger point chart) for points that are sore, and ideally that reproduce the very sensation you’ve been experiencing. Third, maintain firm pressure on the epicenter of the point (with a finger, elbow, ball, or other tool) for about half a minute, consciously breathing into the area and intending to let it go, until there’s a palpable release. Then move on to all the other nearby points that are tight and tender and do the same.
This approach is called ischemic compression. By compressing the tissue enough to block blood flow, the body responds with reflex vasodilation, meaning it opens these vessels and flushes the tissue with a dramatic increase of blood. This will usually produce a significant improvement in the pain or dysfunction, though it will typically return sooner or later. These points tend to go from being active trigger points to “latent” trigger points, which have a certain “memory” (not the good kind of muscle memory) and are capable of getting reactivated. For this reason, persistence is important. The best results come from working on a trigger point consistently – usually from one to several short sessions per day (or less frequent if the sessions are intense) – and continuing for a while even after everything seems better.
As I said, this is a most basic approach, and while it’s often effective, sometimes a more nuanced intervention is required. There are many techniques that build on compression. We can replace fixed pressure with slow, deep strokes in the direction of the muscle fiber, as if re-lengthening this segment. We can work the trigger point back and forth across the direction of the muscle fibers. We can combine pressure on the trigger point with engagement of the affected muscle or antagonistic muscles. We can combine manual work on trigger points with topical herbs and/or internal herbs and nutrients that improve circulation and reduce inflammation. We can utilize release points on the same acupuncture meridian as where the trigger point occurs - or complementary points on other parts of the body. And more.
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free, where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
While I said I believe trigger points are the cause of most of our physical pain, I think it’s worth mentioning there are usually even deeper causes, such as stress and withheld emotions, poor body mechanics, dehydration, and an inflammatory diet. Holistically addressing these issues will lead to a more complete resolution of the condition. Always look at the big picture.
Be well,
Dr. Peter Borten
[post_title] => The Science Behind Our Pain: Inquiring Minds Want to Know
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I love cookies of all kinds. At times my wife or kids have made a batch of cookies and – after they each tried one – I quietly finished off all the rest. So I know a thing or two about restraint and lack thereof. Last week I wrote about smoking and a process for making quitting easier. Today let’s look at how we can adapt this process for a healthier relationship with food.
Often we eat in a way that’s out of sync with what’s best for the body (and mind). The most prevalent example is overeating – i.e., eating beyond the point at which we’re no longer hungry. We do this for many reasons: because the food is tasty, because we were taught to empty our plate, because we don’t want to waste food or insult the cook, because of biological mechanisms designed to protect us against famine, or because we’re simply eating on “autopilot.”
Another example is low quality foods. High sugar foods, for example, can suppress the immune system, cause excessive weight gain, promote inflammation, and lead to insulin resistance (type 2 diabetes). Deep fried foods have similar impacts – promoting inflammation and contributing to cardiovascular disease, type 2 diabetes, obesity, and cancer. I won’t list all the examples here, but if it’s highly processed, contains artificial colors and flavors, white flour, chemical preservatives, or was purchased at a gas station, it probably falls into this category.
Other foods may be essentially benign but not good for a given individual because of a personal sensitivity. Since starting to treat people in the late 90s, I’ve seen a huge increase in patients’ awareness of the foods they’re sensitive to. On the whole this is a great thing, though it’s not always easy for people to avoid these foods – even knowing they’ll feel bad later.
For what it’s worth, I try not to entirely forbid any foods, because of the repercussions of setting up a system of deprivation and rebellion. Besides, we can only maintain discipline for so long. Our willpower wanes when we’re tired, hungry, or stressed. And we all occasionally find ourselves in dining situations where there simply aren’t healthy options.
I believe there’s a time and place for almost any food – including cheesecake and French fries – as long as we practice moderation and mindfulness. When these foods constitute a significant portion of our diet, and/or we’re experiencing negative impacts from consuming them, and/or we can’t control ourselves, this should tell us that something needs to change.
For the bulk of our history as a species, food scarcity was one of our main challenges. Now, in much of the world, this has been replaced by the challenge of restraint.
Healthy restraint with food can be as challenging as dealing with a smoking addiction or alcoholism. At least a smoker or alcoholic has the option of entirely removing cigarettes and alcohol from their life. But we’re obligated to keep eating. The closest equivalent we can exercise is to remove from our cupboards the foods that we have the most difficulty with.
Furthermore, almost everyone has beliefs and baggage wrapped up around food and body image, which complicates our relationship with eating. My purpose today isn’t to completely unpack this whole topic, but to just address one aspect of the pattern – restraint around eating in a way that we know isn’t good for us.
Here are seven steps you can take to feel clearer and stronger about what you feed your body:
1: Setting the stage and loving yourself. Make it easy for yourself to succeed and harder for yourself to overeat, to eat unconsciously, or to eat foods that aren’t good for you. These choices are about avoiding or cleaning up the environments that promote poor eating habits; setting some basic ground rules for yourself – except we’re not going to call them rules, but basic standards; honoring the process of nourishing yourself; and remembering that you are worth treating yourself well.
Eat only in a proper dining setting – not at your desk, not in front of a TV, not while driving, not between meals, not while in a meeting – you’re better than that. Get the junky stuff out of your house. Don’t go to fast food restaurants. Tell your coworkers you’re not eating that stuff anymore, so please don’t even offer you a cupcake – you’re better than that too! Bring your own lunch. Eat a healthy meal before the party. Don’t hang out by the food table.
2: Use empowering language. Instead of telling yourself, “I can’t eat that donut” or “I shouldn’t eat those French fries,” use verbiage that conveys power and choice. Some examples: “I don’t eat garbagey foods. I don’t put that crap in my beautiful body. I choose to be a healthy eater. I choose to love myself so much that I only eat really high quality food. I don’t overeat. I choose to stop eating before I’m full. I feel great when I feed myself well.”
3: Slow down and breathe. Slowing down the eating process makes it easier to perceive when you’ve had enough, and also to feel if your body doesn’t like what or how you’re eating. Before you eat something you know isn’t great for you, take at least one deep breath. You’re creating space so that the behavior isn’t automatic and unconscious.
4: Tune in to the underlying feeling. If you’re wanting to eat something unhealthy, or to continue eating even though you know you’re not hungry anymore, tune in to the feeling that’s urging you to do this. Just take a moment to visit it. If it helps, tell yourself, “You can still have the treat afterwards. We just going to do this first.” Often this feeling is below your radar and you respond to it unconsciously by eating and eating. Let’s make it conscious. Drop into your body and feel what’s happening. What does it feel like? An anxious, unsettled feeling? An empty, yearning feeling? Numbness? Whatever you feel, see if you can simply be with it for a moment, without any resistance. Let yourself feel it fully. Take a breath into it. Allow it to pass through you and depart. What happens? Even if you still eat the food in question, this is nonetheless a useful process.
5: Ask your body. If you’re on the verge of eating in an unhealthy way, just take a second to ask inwardly, “How do you feel about my eating this?” Then feel and listen for the response. Maybe you won’t perceive anything, but maybe you’ll feel a very clear, “No thanks” or “I’m good” or “Sure!” or “Please don’t.” I know you haven’t always loved the way your body has looked and felt and performed for you, but consider being friends with it and honoring its feelings about what’s best for it.
6: Give all your attention to the act of eating. It would be excellent if we could all give our full attention to the act of eating throughout every meal. Eating mindlessly doesn’t just make us prone to doing something that’s not good for us, it also means we’re missing out on fully enjoying the food and missing out on the beautiful, sacred, self-loving act of feeding ourselves and connecting to the fruitful earth that provided it.
It’s especially useful to give your full attention to the act when you’re knowingly eating in a way that’s not ideal for you. Let’s say you decide to have some chocolate mousse. You know it’s not a health food, but it’s going to be incredibly delicious, and sometimes that’s a worthwhile tradeoff, because savoring deliciousness has some value too. This only makes sense, of course, if you’re going to be fully present for the deliciousness experience. Enjoy the hell out of it. Don’t speak. Don’t listen to anything but your own chewing and moaning. Don’t go fast.
7: Let go of the guilt. I know it’s easier said than done, but let’s not add insult to injury. Guilt is the worst thing you can sprinkle over your meal. I believe that feelings of guilt, shame, and self-hate have a tangible impact on what happens to that food after you’ve eaten it. You’re not going to digest it as well, be nourished as thoroughly, or clear out the waste as efficiently if you’re in emotional upset about it. If you’re feeling heavy afterwards, take at least a moment to forgive yourself.
It’s understandable that you would eat this way, because it’s SO freakin’ scrumptious.
It’s understandable that you would eat this way, because you’re stressed and eating is soothing.
It’s understandable that you would eat this way, because your ancestors didn’t have enough to eat and wired you to eat as much as you could when you had the chance.
It’s understandable that you would eat this way, because you’re upset with yourself or displeased with your body.
It’s understandable that you would eat this way, because it makes you feel more in control.
It’s understandable that you would eat this way to get back at people who have mistreated you or objectified your body.
It’s understandable that you would eat this way, because you’re upset with the world for telling you to look like an ideal that’s only possible for a small portion of the population.
It’s understandable that you would eat this way, because you feel deprived or lonely or sad or ungrounded or empty or anxious.
All of this is understandable. AND, you know that there are healthier ways to feel better than by taking it out on your body. Ask your body to forgive you for not always treating it well. Thank your body for being the vehicle that has made this incredible life possible. Take ownership of your body. Forgive your body. Love your body.
Be well,
Peter
[post_title] => Seven Steps for Managing the Habit of Unhealthy Eating
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Gratitude is the understanding that many millions of things come together and live together and mesh together and breathe together in order for us to take even one more breath of air, that the underlying gift of life and incarnation as a living, participating human being is a privilege; that we are miraculously, part of something, rather than nothing. – David Whyte
Coincidentally, I encountered this quote shortly after hearing a lecture on happiness in which the speaker asserted that when we truly recognize our privilege, we readily feel enthusiastic and grateful about whatever we’re engaged in, work included.
It’s easy to forget to be grateful though, just as it’s natural to expect life to continue in roughly the way it always has, with ample clean air, water, food, electricity, safety, and everything else that supports us. Sometimes it’s not until we experience contrast that we recognize our privilege.
Having a period of sickness makes us appreciate our health. Smoky air makes us appreciate fresh air – and firefighters and rain. Traveling in an area with mediocre food options makes us appreciate farmers’ markets and well-stocked grocery stores. All of our adversity, including even our day-to-day micro-adversities, can become prompts to recognize what’s still working and good in our life. You can even try making a rule for yourself that every time you complain about something – even just to yourself – you follow it with a statement of gratitude.
When traffic is bad, what’s good? When there’s pain in your back, what parts of your body still work well and feel okay?
Of course, we don’t need to wait for suffering in order to pay attention to our gifts. It’s just that suffering – especially when it’s really painful – has a way of capturing our attention. The key is the paying attention, and we’re in the habit of letting our attention go to whatever’s loudest or most dramatic, like media, interpersonal conflict, and worry.
Sometimes we need to grab our attention and put it on something else. And when I say “sometimes” I mean virtually all the time – choosing intentionally what we’re putting our attention on. Might I recommend a good place to put it: on the total experience that is happening right here, right now. Your breath and the air entering and exiting your lungs. What it feels like in your body. What you’re currently engaged in. The land you’re sitting on. The beating of your heart. The sun illuminating the world. The soft clothes on your skin. The feeling of the earth’s gravity acting on you.
We want to feel spontaneous gratitude, the exalted kind that comes to us with strong emotion, rather than needing to prompt ourselves to think of something to be grateful for. But the chosen form isn’t any less real. And it has the same benefits of promoting happiness, broadening our perspective, and focusing our energy on good things.
I am grateful for you.
Love,
Peter & Everyone at the Dragontree
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A couple weeks ago, I wrote about the differences between acupuncture and “dry needling” to alleviate pain, and in that article I explained a bit about the phenomenon of myofascial trigger points. After I said I believe these are the cause of most of the physical pain humans experience, a number of readers asked me to explain more. For the science lovers out there, I’m going to dive deeper this week.
Besides the most common forms of pain, like lower back and headaches, I’ve had patients with digestive problems, sinus congestion, chest pain, ear ringing, numb hands, painful intercourse, acid reflux, vision changes, and other health issues that were eventually discovered to be due to myofascial trigger points. I believe everyone should know about them and how they work – it could save us a lot of time and worry.
Basically, a trigger point is a small, irritable region in a muscle (or the surrounding connective tissue – “fascia”) that stays stuck in a contracted state, making the muscle fibers taut. This can cause reduced muscle strength and range of motion, pain, numbness, itching, and other forms of dysfunction. Sometimes a trigger point feels like a palpable nodule or “knot,” but to untrained fingers they’re often tricky to find.
A unique property of trigger points is that they’re able to produce symptoms in other parts of the body – from a few inches to a couple feet away. For instance, there’s a trigger point that can form in the soleus muscle of the calf that’s capable of producing pain in the lower back. For this reason, the work of Janet Travell, MD and her colleague David Simons, MD, was groundbreaking. For each muscle in the body, they mapped where trigger points tend to form and what kinds of symptoms they cause.
If you were experiencing pain along the outside of your leg, you might assume that something was wrong with that part of your leg, perhaps with the often-tight iliotibial band (IT band). But this diagram might be helpful. The X’s show where trigger points can occur in a muscle called gluteus minimus above the hip socket. The red shading shows the potential areas of pain that can result. You might not suspect this muscle because, as you can see, there’s no pain at the site of the problem!
There are a handful of mechanisms that can promote trigger point formation, such as irritation of nerves, chronic organ problems, nutritional deficiencies, and autoimmune disorders. Most often, though, the cause is trauma to our connective tissue. When a muscle is strained by being worked too hard, too fast, or beyond its natural range, there is frequently a sort of “recoil” that occurs as segments of the muscle fibers bunch up and remain that way.
This is especially common when someone works out without warming up; when someone does a very ambitious workout after not having exercised for a long time; when someone makes a sudden movement (like reaching out to catch something or trying to stop oneself from falling); and especially when someone does any of the above when in a state of diminished resilience (e.g, when stressed, upset, sleep deprived, eating poorly, etc.).
Even more commonly, the trauma is a form of “postural stress” that’s demanding on muscles in a way that’s difficult to perceive at the time – such as doing the same relatively motionless activity (like sitting at a desk or driving) for hours, days, months, or years. One possible mechanism is known as the “Cinderella hypothesis.” During static muscle exertion – holding a position for a long time, as dentists, musicians, typists, and others engaged in precision handwork do – the body tends to engage a certain group of small muscle fibers, called Cinderella fibers because they’re put to work first and are the last to be disengaged. Even though they’re not doing heavy lifting, these muscle fibers (often in the neck, shoulders, back, and forearms) are continually activated and overworked, which makes them susceptible to trigger point formation.
Whatever the cause, the result is that eventually the muscle never completely relaxes. Muscles are composed of numerous parallel fibers that work together to shorten (contraction of the muscle) and lengthen (the return of the muscle to its relaxed state). Within each of these fibers are many end-to-end contractile units called sarcomeres, and in the case of a trigger point, a group of sarcomeres gets “stuck” in a shortened state. This makes the affected fibers taut and often “stringy” feeling.
To make matters worse, the contracted region clamps down on tiny blood vessels causing local ischemia (inadequate blood supply), reducing in-flow of fresh, oxygenated blood and out-flow of toxins. This leads to a localized hypoxic state (not enough oxygen). The tissue pH changes, local metabolism is impaired, and fluid and waste products tend to build up in the area. This combination of factors ultimately activates pain receptors – it starts to hurt – and when this happens you use the affected muscle less.
Instead, you overload “synergists” – nearby helper muscles. The body makes the surrounding musculature tense as a protective mechanism. Meanwhile, there’s a disruption of the balance between the affected muscles and their “antagonists” – those muscles that lengthen when the primary muscles shorten and vice-versa (for example, the triceps is an antagonist of the biceps). Altogether, this restricts natural movement of the original muscle, which just perpetuates the imbalance. Finally, with longstanding trigger points, the body may deposit gooey lubricant compounds called glycosaminoglycans (GAGs) between these triggered muscle fibers, resulting in a gummy lump called a “myogelosis.”
The good news is that there are now books, charts, online tools, and practitioners that can help track down likely trigger points that may be implicated in your discomfort. I have such a tool in my online pain relief course, Live Pain Free, and I teach many approaches for deactivating trigger points.
The most basic methods involve simple mechanical disruption of this holding pattern. First, drink some water if you’re not well hydrated. Second, you or a friend can methodically feel around (ideally guided by a trigger point chart) for points that are sore, and ideally that reproduce the very sensation you’ve been experiencing. Third, maintain firm pressure on the epicenter of the point (with a finger, elbow, ball, or other tool) for about half a minute, consciously breathing into the area and intending to let it go, until there’s a palpable release. Then move on to all the other nearby points that are tight and tender and do the same.
This approach is called ischemic compression. By compressing the tissue enough to block blood flow, the body responds with reflex vasodilation, meaning it opens these vessels and flushes the tissue with a dramatic increase of blood. This will usually produce a significant improvement in the pain or dysfunction, though it will typically return sooner or later. These points tend to go from being active trigger points to “latent” trigger points, which have a certain “memory” (not the good kind of muscle memory) and are capable of getting reactivated. For this reason, persistence is important. The best results come from working on a trigger point consistently – usually from one to several short sessions per day (or less frequent if the sessions are intense) – and continuing for a while even after everything seems better.
As I said, this is a most basic approach, and while it’s often effective, sometimes a more nuanced intervention is required. There are many techniques that build on compression. We can replace fixed pressure with slow, deep strokes in the direction of the muscle fiber, as if re-lengthening this segment. We can work the trigger point back and forth across the direction of the muscle fibers. We can combine pressure on the trigger point with engagement of the affected muscle or antagonistic muscles. We can combine manual work on trigger points with topical herbs and/or internal herbs and nutrients that improve circulation and reduce inflammation. We can utilize release points on the same acupuncture meridian as where the trigger point occurs - or complementary points on other parts of the body. And more.
If all of this sounds interesting and relevant to you, I encourage you to do a little research. It might well be the end of a problem you thought had no solution. And if you need more guidance, check out my online course, Live Pain Free, where I go deeper into trigger points and much, much more to help people get out of pain of all kinds.
While I said I believe trigger points are the cause of most of our physical pain, I think it’s worth mentioning there are usually even deeper causes, such as stress and withheld emotions, poor body mechanics, dehydration, and an inflammatory diet. Holistically addressing these issues will lead to a more complete resolution of the condition. Always look at the big picture.
Be well,
Dr. Peter Borten
[post_title] => The Science Behind Our Pain: Inquiring Minds Want to Know
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